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Following is a question by the Hon Law Chi-kwong and a written reply by the Secretary for Health and Welfare, Dr E K Yeoh, in the Legislative Council today (November 7):
Question :
Regarding the provision of infirmary services for the elderly, will the Government inform this Council:
(a) of the respective numbers of elderly persons waiting or qualified for admission to the infirmaries under the Hospital Authority ("HA") among all those who are living in various types of residential care homes for the elderly ("RCHEs");
(b) of the unit cost of an infirmary bed under the HA; and the respective unit costs of taking care of the elderly persons who are qualified for admission to RCHEs in various subsidized RCHEs and private RCHEs which participate in the Bought Place Scheme or the Enhanced Bought Place Scheme;
(c) whether assessment and comparison have been made regarding the service quality of the infirmaries under the HA, subsidized RCHEs and private RCHEs in taking care of vulnerable elderly persons; if so, of the results; and
(d) whether it will consider allowing RCHEs to provide infirmary services as well, with a view to enhancing the coordination and continuity of services for the elderly; if not, of the reasons for that?
Reply :
Madam President,
(a) The waiting list for infirmary places under the Hospital Authority (HA) comprises both elders assessed to be eligible for admission and those who have not yet undergone assessment. The breakdown of applicants on the waiting list who are residing in residential care homes for the elderly (RCHEs) as at 30.9.2001 is as follows:
Type of RCHE Number of Applicants
Subvented Hostel/Home for the Aged 43
Subvented Care and Attention Home 1,090
Subvented Nursing Home 64
Non-subsidized Home 2,467
(b) The cost per day for an infirmary bed under HA is about $1,000. Infirmary care under HA targets at patients whose illnesses and disabilities require continuous professional medical and/or nursing care.
The various types of subsidized residential care services for elders cater for elders with different levels of care needs. Homes for the Aged serve primarily elders with mild level of impairment with a certain degree of self care capability and who may need assistance in performing some household duties. Care and Attention Homes, including those which have joined the Bought Place Scheme/Enhanced Bought Place Scheme, mainly target at elders at moderate level of impairment who require personal care and attention in the course of daily living activities but do not require a high degree of professional medical and nursing input. Nursing homes provide care to elders suffering from severe level of impairment and who require regular basic medical and nursing care. The monthly unit costs of these different types of subsidized services borne by the government are:
Type of Place Monthly unit cost(1)
Subvented Home for the Aged $4,027
Subvented Care & Attention Home $8,690
Subvented Nursing Home $12,776
Bought Place Scheme $5,036
Enhanced Bought Place Scheme $6,343
Note: (1) Excluding user-fee to be paid by the resident.
In addition to the above, the following extra resources are provided:
* one Registered Nurse and 4 Enrolled Nurses are provided to each of the 29 Infirmary Units set up in subvented Care & Attention Homes to serve a total of 580 elders assessed to be in need of infirmary care;
* the Infirmary Care Supplement (ICS) has been introduced for application by subvented RCHEs to enable them to take care of additional elders assessed to be in need of infirmary care. In the financial year 2001-02, the amount earmarked for ICS is about $29.64 million; and
* the Community Geriatric Assessment Teams under HA provide geriatric care to elders in all subvented residential care homes and the majority of the private care homes.
Direct comparison between the costs of an infirmary bed under HA and other types of subsidised residential care services for elders should not be made as the basis for calculation is different and the nature of service provided is dissimiliar.
(c) As the target group of infirmary care provided by HA is by and large different from that of subvented and private residential care homes under the remit of Social Welfare Department (SWD), we have not conducted any comparison studies between the service quality of these two types of services. However, both HA and SWD have their own mechanisms to ensure service quality.
Infirmary care is part and parcel of the services under HA and is therefore subject to the standards for professional services provided by hospitals. Quality monitoring and improvement measures adopted include practice guidelines and quality indicators. Regular training programmes are organized to enhance the knowledge and skills of staff working in infirmary units.
For residential care services for elders, SWD monitors on a regular basis the compliance by all RCHEs with the standards stipulated in the Residential Care Home (Elderly Persons) Ordinance, its subsidiary legislation and the Code of Practice. In addition, SWD has introduced the Service Performance Monitoring System for subvented RCHEs. Under the system, subvented RCHEs are evaluated against a set of 16 well-defined Service Quality Standards. SWD has also applied these standards to homes that have joined the Enhanced Bought Place Scheme.
(d) To enable our elders to age in a familiar environment, we are progressively introducing the concept of 'continuum of care' to both home and community and residential care services. We will continue to build on our cornerstone policy of 'ageing in place', and expand, re-engineer and integrate the long term care services to meet the changing needs of our growing elderly population in a comprehensive and client-centred manner. In the longer term and in the context of developing the 'continuum of care' concept, we will explore an optimal model of long term care including the interface with medical care and identify the most appropriate and qualified organization to operate it.
End/Wednesday, November 7, 2001
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